Provider Demographics
NPI:1366695975
Name:MESILLA VALLEY HOSPITAL
Entity type:Organization
Organization Name:MESILLA VALLEY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-382-3500
Mailing Address - Street 1:3751 DEL REY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7710
Mailing Address - Country:US
Mailing Address - Phone:575-382-3500
Mailing Address - Fax:
Practice Address - Street 1:3751 DEL REY BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-7710
Practice Address - Country:US
Practice Address - Phone:575-382-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM99-336283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH19302Medicare UPIN